Obstetric anaesthesia and peripartum management.

Anaesthetists play a key role in the management of parturients with cardiac disease. Pregnant women with cardiac disease should be seen antenatally in a high-risk obstetric anaesthesia clinic, and a comprehensive management plan formulated. Most women with cardiac disease can have a vaginal delivery, and early epidural analgesia is frequently considered beneficial. No evidence exists to definitively support either regional or general anaesthesia for caesarean section, and much depends on the urgency of the procedure and the severity of disease. Women with the most severe forms of cardiac disease should be managed by a consultant anaesthetic team, with experience of both cardiac and obstetric anaesthesia.